Plantar FasciitisPlantar fasciitis is an overuse injury affecting the plantar fascia in the sole of the foot. The tough, fibrous fascia connects the heel bone to the base of the toes. Inflammation from overuse leads to pain. Those most at risk include women, overweight people, and those who are on their feet most of day walking or standing on hard surfaces. The AOFAS says that over 50 percent of those with plantar fasciitis are on their feet nearly all day. Walking or running for exercise also puts people at risk. The AOFAS says that about 90 percent of people with plantar fasciitis improve with simple exercises, wearing heel cups, and other non-invasive treatments. But for those who have no relief, surgery or the newer shockwave therapy may be an option.
Shock Wave Therapy for Plantar FasciitisIn "Extracorporeal Shock Wave Therapy for the Treatment of Plantar Fasciitis," researchers found low energy shock wave therapy to be an effective treatment for heel pain. "I think that shock wave therapy offers another alternative for non-invasive treatment of plantar fasciitis," said Christopher Zingas, MD, Detroit Michigan, an AOFAS member and co-author of the study in the press release.
About the Shock Wave Therapy StudyThis blind study used low energy shock wave therapy done in the doctor's office to treat patients with heel pain who might otherwise have been surgical candidates. Some of the patients received a placebo treatment rather than receiving shock wave therapy. After three months, 62% of the group receiving shock wave treatment improved and 39% receiving the placebo treatment also improved. "In office procedures of low energy shock wave therapy showed similar results to previous reports of high energy shock wave therapy," said Dr. Zingas in the press release. After a year of treatment, over 90% of patients had shown improvements.
High Energy vs. Low Energy Shock Wave Therapy"The most important difference between high and low energy shock wave therapy is the amount of sedation/anesthesia needed," said Dr. Zingas. "With high energy the patient needs to be under heavy sedation or general anesthesia. This need for anesthesia and conscious sedation restricts usage of the device to surgical centers and requires an anesthesia team."
Using low energy shock wave therapy as a treatment for heel pain is a relatively new procedure that may potentially become a common office treatment option. "I believe that in the future, shock wave therapy will offer another conservative treatment modality for patients with plantar fasciitis," said Dr. Zingas. "However, much more work needs to be done in order to determine the best protocols and patient selection for the use of shock wave therapy."
High Energy Therapy Helps Those With Chronic Plantar FasciitisIn "Bilateral Chronic Proximal Plantar Fasiopathy: Treatment with Electrohydraulic Orthotripsy," researchers found high intensity shockwave therapy to be an effective treatment option for patients with long standing heel pain. "Three quarters of patients show great results after just one treatment of high intensity shockwave therapy," said John A. Ogden, MD, of Atlanta, Georgia, co-author of the study.
The study examined patients who had long standing heel pain which did not respond to other more conservative methods of treatment. The shockwave therapy also was administered to both heels in many cases, which was different from previous studies done through the FDA. "In this study both heels were treated with great success," said Dr. Ogden. "Patients can very rapidly return to both work and athletic related activities."
Shock wave therapy usually allows for patients to return to their daily activities within a day of the treatment. "Normally it is not possible to treat both heels at a time because a patient would probably have to be put in a wheelchair," said Dr. Ogden. "When I use shock wave therapy they can go back to work the next day."
Given the success of this study, shock wave therapy is now being used in many other procedures. "We are trying to increase the utilization of the technology of shock wave therapy beyond the foot and ankle, to all parts of the body," said Dr. Ogden.
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Source: Press Release, American Society of Foot and Ankle Surgeons, May, 2004.